]]>2017-08-11T02:33:51-07:00info:doi/10.1136/medhum-2017-011265hwp:master-id:medhum;medhum-2017-011265Institute of Medical Ethics2017-08-11Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011225v3?rss=1
My telomeres are endless,

Nanobots course through my blood,

Not a cyborg,

No 3D-printer organ curiosities,

Evolution speculation,

Imagined.

­

On ethical dunes that scatter and reform,

Tenuous bindings from your unenlightened age,

Your history leads to me,

You wanted me,

Yearned for me.

­

Know all you create,

I am You,

A creator,

A destroyer,

In perpetua.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-08-09T09:04:21-07:00info:doi/10.1136/medhum-2017-011225hwp:master-id:medhum;medhum-2017-011225Institute of Medical Ethics2017-08-09Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2016-011179v1?rss=1
It is a distinctive feature of HIV that its pathology cannot be adequately grasped separate from a number of psychosocial factors, and stigma is widely seen as the most prominent. We argue that it is equally important to have an adequate understanding of shame, as the emotional response to stigma. We have identified five ways shame might negatively impact upon attempts to combat and treat HIV, which emerge from the stigma HIV carries and STI-stigma in general. In this paper, we draw out four insights from philosophical work on emotions and shame which we propose will improve understanding of shame and stigma. We conclude by briefly discussing how these insights might shed light on the negative role shame can play for a person living with HIV engaging with, or being retained in, care. We conclude by proposing further study.]]>2017-08-08T09:03:56-07:00info:doi/10.1136/medhum-2016-011179hwp:master-id:medhum;medhum-2016-011179Institute of Medical Ethics2017-08-08Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011140v2?rss=1
There are limited curricular options for medical students to engage in art-making during their training. Yet, it is known that art-making confers a variety of benefits related to learning. This qualitative study utilises a visual methodology to explore students’ art-making in the context of the cardiovascular sciences. The existence of a multiyear repository of medical/dental student generated, cardiac-inspired art, collected over 6 years, provided the opportunity to explore the nature of the art made. The aim was to categorise the art produced, as well as the depth and breadth of understanding required to produce the art. The data set included a wide variety of titled art (paintings, photographs, sketches, sculptures, collages, poetry and music/dance). Systematic curation of the collection, across all media, yielded three main categories: anatomical renderings, physiology/pathophysiology renderings and kinesthetic creations (music/dance/tactile). Overall (medical and dental) student-generated art suggested a high level of content/process understanding, as illustrated by attention to scientific detail, integration of form and function as well as the sophisticated use of visual metaphor and word play. Dental students preferentially expressed their understanding of anatomy and physiology kinesthetically, creating art that required manual dexterity as well as through choreography and dance. Combining art-making with basic science curricular learning invited the medical and dentistry students to link their understanding to different modes of expression and a non-biomedical way of knowing. Subsequent incorporation of the student-generated cardiac art into lectures exposed the entire class to creative pictorial expressions of anatomy, physiology and pathophysiology.]]>2017-08-01T09:03:24-07:00info:doi/10.1136/medhum-2016-011140hwp:master-id:medhum;medhum-2016-011140Institute of Medical Ethics2017-08-01Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011290v3?rss=1

Red ribbons cut by the blissful sliver,

One of many trying not to quiver,

A grizzled man with cold dead steel,

The stain of death closes the seal,

Inky blackness all consuming,

Only feeling is slowly moving,

Closer, but just out of reach,

Light is back, dark thoughts impeach,

Take this hand and we shall see,

If the lock is lost and we've found the key,

For all is nought without this grip,

So squeeze these fingers and pray; don't slip.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-07-27T09:03:34-07:00info:doi/10.1136/medhum-2017-011290hwp:master-id:medhum;medhum-2017-011290Institute of Medical Ethics2017-07-27Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011266v2?rss=1

I want to give you a gift.

The side of her you could never see.

The sober moments when her addictions were briefly quieted.

She loved you, sobbed with shame and grief,

In the brief clarity of the hospital pulling herself together.

You’ll never know this.

Never see the side of her that ached for a normal life with you.

­

You know the cloud, the avalanche.

Gathering speed.

Fueled by the weight of your life as a ward of the state.

Gathering speed.

The inevitable end you would hear from a social worker.

But this gift, you deserve it.

To know there was a cement of love among the cracks.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-07-26T09:03:32-07:00info:doi/10.1136/medhum-2017-011266hwp:master-id:medhum;medhum-2017-011266Institute of Medical Ethics2017-07-26Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011277v1?rss=1

What did he already know, straddling his mother’s broad lap,

hiding his face, listening at our halting and stuttering and murmuring babble,

the nonsensical sounds of statistics and ‘choices’ rushing like noise,

perplexing his parents past their own understanding,

shifting from one leg to the other, unfathomed,

watching the waters well up around him, then spill,

Of the future, for the first time foreseen,

far from the red-and-blue striped swingsets

and the ants and the pebbles at the playground,

far from the bright candy wrappers at the deli,

and his mother’s silken neck, where he loved to rub his hot cheek?

Tonio turned, eyes wide, cried and clung a while,

his tears obscuring the flood of our own fears.

Slowly the quietness of the small room returned.

He had spied the box of silly, tattered toys;

he wanted them, right now, endearing just for the present,

silent of their own irrelevant past.

Disclaimer

This is a heavily revised new version of a poem that had been previously published...]]>

2017-07-24T09:03:59-07:00info:doi/10.1136/medhum-2017-011277hwp:master-id:medhum;medhum-2017-011277Institute of Medical Ethics2017-07-24Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011272v1?rss=1
the page bleeps relentlessly

a chain of patients still to see

and the phone rings rings again

spot tests nebs bloods LP

awaiting results but treat IV

the page bleeps relentlessly

cannula fails dad complains

calm situation hit the vein

and the phone rings rings again

toddler bruising no history

parents aggressive contradictory

the page bleeps relentlessly

resus breathless call ITU in

no local beds or transfer ‘til ten

and the phone rings rings again

night reg sick no capacity

negotiate maintain endlessly

the page bleeps relentlessly

and the phone rings rings again

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-07-14T09:03:26-07:00info:doi/10.1136/medhum-2017-011272hwp:master-id:medhum;medhum-2017-011272Institute of Medical Ethics2017-07-14Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011257v2?rss=1

She sat in bed, a room to drama given

Not often or of late. With her a throng

Of fellow teens, all smiles as if room seven

Were home, were Méjico, speaking the tongue

I'd learned one college summer with aims

Of studying pre-Columbian deities -

Those eyeless gods of stone and clay with names

Like Ixtacíhuatl, snow capped queen of trees.

Ciega. Blind. Mi chica had no sight.

I looked into her eyes and saw two suns

Of blinding white - atrophic holes, where light

Fell off the cliff to disappear, forever gone:

Her aqueous flowed but poorly from her eyes.

For Ixtacíhuatl, a maiden sacrifice.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-07-13T09:03:28-07:00info:doi/10.1136/medhum-2017-011257hwp:master-id:medhum;medhum-2017-011257Institute of Medical Ethics2017-07-13Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011230v1?rss=1
Translation of curriculum materials to digital formats has become increasingly common. Medical humanities, typically reliant on human interaction to generate emotional impact, represents an interesting means to study engagement with digitised content. While technology-enhanced learning may provide opportunities to integrate humanities into curricula, redesigning sessions for digital use can be resource intensive and ‘requires consideration of the affordances’ of different media.1 As previously reported in BMJ Medical Humanities, guidance for this process—beyond simply, ‘digitising existing content’—remains limited.1 We present a five year educational case study that outlines our successes and struggles with digitising a medical humanities session for undergraduate medical education.

Our model uses, Ed’s Story: the Dragon Chronicles, a verbatim play based exclusively on the journal of a 16 year-old boy with terminal cancer, and 25 interviews conducted after his death with his family, friends and interdisciplinary healthcare team.2 We have described the play’s development and initial curriculum...]]>

ARLM is a respiratory consultant working and living in Bristol, UK. The poem is a reflective following the diagnosis of type two diabetes to give an insight into the experience of unpredictable yet debilitating apparently invisible illness.

]]>2017-07-12T09:03:23-07:00info:doi/10.1136/medhum-2017-011269hwp:master-id:medhum;medhum-2017-011269Institute of Medical Ethics2017-07-12Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011262v1?rss=1
Do we feel it - do we miss it?

The word unspoken but implicit;

the heart symbol drawn – unsaid;

thoughts of love, though not explicit.

Do we think it - do we believe it?

Connection lost behind jagged lines;

swirls of emotion - the ache of now;

the coiled snake, fearful signs.

Do we know it - do we see it?

The search for meaning making;

the desire to paint it, dance it;

aching for a way of speaking.

Do we hear it - do we perceive it?

Open the closed, find curved lines,

ways around to explore, to find;

clear the thinking with creative mind.

Do we read it - echo the song of it?

It’s powerful, this thinking out loud,

this music of freedom and life:

it’s straightforward and proud.

Do you sense it - are you stirred by it?

More than being bruised to the bone;

Hope beyond cure, family, friends, home, or me:

there is peace – faith – calm.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer...]]>

2017-07-11T09:03:48-07:00info:doi/10.1136/medhum-2017-011262hwp:master-id:medhum;medhum-2017-011262Institute of Medical Ethics2017-07-11Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011198v1?rss=1
Erotomania has a long, colourful history in psychiatry. It is a rare condition in which the patient (‘subject’) develops the belief that he or she is loved from afar by another person (‘object’). The subject is generally female, though men predominate in forensic samples. The object is generally perceived to belong to a higher social class, reflecting a sociopolitical element in the construction of love. Erotomania requires active treatment and risk management as it can be associated with stalking and other offending behaviour. In addition to featuring in the psychiatry literature, erotomania features in the biography of the economist John Maynard Keynes (the apparent ‘object’ of a woman’s erotomanic delusions in the early 1900s) and in fiction (eg, Ian McEwan’s Enduring Love); this reflects, in part, the general popularity of romantic themes in broader literature and society. In psychological terms, certain cases of erotomania might be underpinned by combinations of longing, disappointment, shame and narcissism in specific social contexts. Lesser forms of delusional exaggeration of true love might also exist in some stable relationships, and might even be essential for their continued existence. Overall, the division between love and delusions of love is not as distinct as one might imagine. The potential presence of an element of delusional love in many relationships might well serve important social functions, conferring specific advantages on the parties involved and increasing social and community stability. After all, delusions persist; love dies.]]>2017-07-08T09:03:37-07:00info:doi/10.1136/medhum-2017-011198hwp:master-id:medhum;medhum-2017-011198Institute of Medical Ethics2017-07-08Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011299v1?rss=1
You spent most your life

]]>2017-07-07T09:03:45-07:00info:doi/10.1136/medhum-2017-011251hwp:master-id:medhum;medhum-2017-011251Institute of Medical Ethics2017-07-07Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011224v1?rss=1
There is a secret self, a shadow

Relax your peepers and you’ll miss her-

Some say she’s not welcome here,

Others that she’s always been

Resting on gyri, enveloped in some sulcus,

She’s very small you know.

­

Her favourite thing is riding the opal-grey seahorses, over and over,

They watch her in wonderment, ache a little at her touch

Other times she sits in an oval orchard,

Feasting on almonds, leaving scatterings

When she is full she wanders along silvery-spindle tracts,

Until she reaches the cusp of the water and waits-

At the point of a kiss

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-07-07T09:03:45-07:00info:doi/10.1136/medhum-2017-011224hwp:master-id:medhum;medhum-2017-011224Institute of Medical Ethics2017-07-07Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011246v1?rss=1
Before there was red, there was orange.

A generation of quiet that lived pale by comparison,

the 1950s were muted.

Dramatics were hidden.

Mystery was timeless.

The frenetic was only for youth.

Orange was a presence that shot straight from elastic into a future that hoped for heaven.

Into living room rugs and 70’s furniture,

an intensity took its place.

Orange was not enough.

Its colour, faded. Its ambition, muddled.

Its pallor, too tarnished to blush.

In a stratagem to overthrow what was once alive and above,

a new generation took place.

"Mom, it’s not a retirement home, it’s a village.

A community. A life of recumbent safety"

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-07-07T09:03:45-07:00info:doi/10.1136/medhum-2017-011246hwp:master-id:medhum;medhum-2017-011246Institute of Medical Ethics2017-07-07Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2016-011061v1?rss=1
Medical photography, and in particular dermatological imagery, is often assumed to provide an objective, and functional, representation of disease and that it can act as a diagnostic aid. By contrast, artistic conceptions of the images of the body tend to focus on interpretative heterogeneity and ambiguity, aiming to create or explore meaning rather than enact a particular function. In her 2015 retrospective exhibition at the Tate Modern, South African artist Marlene Dumas questions these disciplinary divides by using medical imagery (among other photographic sources) as the basis for her portraits. Her portrait ‘The White Disease’ draws on an unidentified photograph taken from a medical journal, but obscures the original image to such a degree that any representation of a particular disease is highly questionable. The title creates a new classification, which reflects on disease and on the racial politics of South Africa during apartheid. Though, on the one hand, these techniques are seemingly disparate from the methods of medical understanding, features such as reliance on classification, and attempts at dispelling ambiguity, bring Dumas’ work closer to the history of dermatological portraits than would usually be perceived to be the case. In considering the continuities and disparities between conceptualisations of skin in dermatology and Dumas’ art, this paper questions assumptions of photographic objectivity to suggest that there is greater complexity and interpretative scope in medical dermatological images than might initially be assumed.]]>2017-06-19T09:03:19-07:00info:doi/10.1136/medhum-2016-011061hwp:master-id:medhum;medhum-2016-011061Institute of Medical Ethics2017-06-19Student original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011186v1?rss=1
Despite shame being recognised as a powerful force in the clinical encounter, it is underacknowledged, under-researched and undertheorised in the contexts of health and medicine. In this paper we make two claims. The first is that emotional or affective states, in particular shame, can have a significant impact on health, illness and health-related behaviours. We outline four possible processes through which this might occur: (1) acute shame avoidance behaviour; (2) chronic shame health-related behaviours; (3) stigma and social status threat and (4) biological mechanisms. Second, we postulate that shame's influence is so insidious, pervasive and pernicious, and so critical to clinical and political discourse around health, that it is imperative that its vital role in health, health-related behaviours and illness be recognised and assimilated into medical, social and political consciousness and practice. In essence, we argue that its impact is sufficiently powerful for it to be considered an affective determinant of health, and provide three justifications for this. We conclude with a proposal for a research agenda that aims to extend the state of knowledge of health-related shame.]]>2017-06-08T09:03:06-07:00info:doi/10.1136/medhum-2017-011186hwp:master-id:medhum;medhum-2017-011186Institute of Medical Ethics2017-06-08Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011209v1?rss=1
This paper argues for an approach within the medical humanities that draws on the theoretical legacy of cultural materialism as a framework for reading cultural practices and their relationship to the social and economic order. It revisits the origins and development of cultural materialism in cultural studies and literary studies between the 1970s and 1990s and considers how, with adaptation, this methodology might facilitate ideological criticism focused on material formations of health, disease and the human body. I outline three key characteristics of a medicocultural materialist approach along these lines: (a) interdisciplinary work on a broad range of medical and cultural sources, including those drawn from ‘popular’ forms of culture; (b) the combination of historicist analysis with scrutiny of present-day contexts; (c) analyses that engage with political economy perspectives and/or the work of medical sociology in this area. The subsequent sections of the paper employ a medicocultural materialist approach to examine conjectural understandings of, and empirical investigations into, the capacity of transfused human blood to rejuvenate the ageing body. I trace textual faultlines that expose the structures of power which inform the movement of blood between bodies in ‘medical gothic’ fictions from the 19th-century fin de siècle, including Mary Elizabeth Braddon's ‘Good Lady Ducayne’ (1896) and Bram Stoker's Dracula (1897). I conclude with a critique of biomedical innovations in blood rejuvenation in the era of medical neoliberalism, before considering the potential applications of medicocultural materialism to other topics within the field of the medical humanities.]]>2017-05-11T09:00:27-07:00info:doi/10.1136/medhum-2017-011209hwp:master-id:medhum;medhum-2017-011209Institute of Medical Ethics2017-05-11Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011227v1?rss=1

Everyone working there, except the pediatrician, spoke two or more languages.

For each young patient, staff would crystallize the medical issue, a terse "chief complaint,"

using the parents' own words, on why they were bothering to see a Western doctor,

even when the children didn't, wouldn't or couldn't complain for themselves.

It's a parent's concern, via a native vernacular, through an interpreter's ear,

twisted with some medical phrasing, a flashing linguistic triple flip,

leaving the doctor to decipher the situation for clinical intervention,

one further contortion in the tumbling run, with the full expectation of a two footed landing.

And this young one predicted earthquakes. Taller and chubbier than expected,

the child hovered outside the door, apparently shy about entering the exam room,

already crowded with adults: his mother, an aunt, an interpreter and a doctor.

He reportedly described earthquakes often; his uncanny timing with the big one scared people.

He spoke no English, and hardly spoke at all, rocking, snuffling and...]]>

2017-05-03T09:00:29-07:00info:doi/10.1136/medhum-2017-011227hwp:master-id:medhum;medhum-2017-011227Institute of Medical Ethics2017-05-03Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011254v1?rss=1

Cocooned in her blanket

She asks again

If I've seen the kitten's photo

Framed at her bedside

He's a big tabby now

And you should see his markings

You should see him now

He is such a handsome cat

All alone in a four bed ward

Her youth stolen by tainted blood

Now cancer invades her

All alone, no one visits

Oncology promised to assess her

No notes in the chart

They haven't come

We remind them once again

With each day

Her will drains

She barely eats

And it grows

Twice more

We do our dance

As her walker gathers dust

As hope fades

Have you seen him?

You should see him now

You should see his markings

He's such a handsome cat

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-05-02T09:00:28-07:00info:doi/10.1136/medhum-2017-011254hwp:master-id:medhum;medhum-2017-011254Institute of Medical Ethics2017-05-02Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011232v1?rss=1

Then there came a time

when my body was set free

by the lost memory

of my mother's loving eyes,

my body set free

to glide high riding

impossibly silent

flowing snowy slopes,

my body set free

to slide skinny

slip-stream strokes through

black and frigid crater lakes.

Set free by a memory

or was it just

wishful thinking

and not a lost memory at all,

not lost like the riding

and sliding.

So now here I lie

convinced that I

am ready to die,

quivering butterfly wings

pinned to crisp white linens.

Here you come now

to my side,

a newborn's cry

meeting mother

eye-to-eye.

What is this gift that

you ask of precious me

like a beggar

kneeling beside my bed

holding my hand

you say

I love you

and I will stay here with you.

Competing interests

None

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-04-27T09:00:44-07:00info:doi/10.1136/medhum-2017-011232hwp:master-id:medhum;medhum-2017-011232Institute of Medical Ethics2017-04-27Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2016-011180v1?rss=1
Empathy is an essential attribute for medical professionals. Yet, evidence indicates that medical learners' empathy levels decline dramatically during medical school. Training in evidence-based observation and mindfulness has the potential to bolster the acquisition and demonstration of empathic behaviours for medical learners. In this prospective cohort study, we explore the impact of a course in arts-based visual literacy and mindfulness practice (Art of Seeing) on the empathic response of medical residents engaged in obstetrics and gynaecology and family medicine training. Following this multifaceted arts-based programme that integrates the facilitated viewing of art and dance, art-making, and mindfulness-based practices into a practitioner-patient context, 15 resident trainees completed the previously validated Interpersonal Reactivity Index, Compassion, and Mindfulness Scales. Fourteen participants also participated in semistructured interviews that probed their perceived impacts of the programme on their empathic clinical practice. The results indicated that programme participants improved in the Mindfulness Scale domains related to self-confidence and communication relative to a group of control participants following the arts-based programme. However, the majority of the psychometric measures did not reveal differences between groups over the duration of the programme. Importantly, thematic qualitative analysis of the interview data revealed that the programme had a positive impact on the participants' perceived empathy towards colleagues and patients and on the perception of personal and professional well-being. The study concludes that a multifaceted arts-based curriculum focusing on evidence-based observation and mindfulness is a useful tool in bolstering the empathic response, improving communication, and fostering professional well-being among medical residents.]]>2017-04-27T09:00:44-07:00info:doi/10.1136/medhum-2016-011180hwp:master-id:medhum;medhum-2016-011180Institute of Medical Ethics2017-04-27Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011245v1?rss=1

A whimsical bark to start,

a slight whistle accompanies,

a burning in the windpipe.

No respecter of Morpheus.

The barks continue as paroxysms,

Becoming more and more frequent,

Poco a poco crescendo

Until all goes quiet

A feeling of eerie hiatus

The pills are swallowed.

The paroxysms eventually begin to dwindle;

But not before another crescendo;

Will it ever end?

The nemetic flute returns,

leader of the orchestra. Beware any silence now,

as Morpheus may never return.

The paroxysms finally pass,

time for Morpheus to return now;

the flute and orchestra take their leave

The opus has concluded.

I suffered from pertussis pneumonia. The symptoms were unpredictable, uncontrollable at times and frightening taking several weeks to subside despite antibiotics. I wrote the poem "paroxysms" after one attack of whooping at night. Dr Medford lives and works as a respiratory consultant in Bristol, UK.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-04-25T09:00:31-07:00info:doi/10.1136/medhum-2017-011245hwp:master-id:medhum;medhum-2017-011245Institute of Medical Ethics2017-04-25Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011238v1?rss=1

Its feigned objectivity

crisply ironed with the cost of ignorance.

Unstained

by the wearer's lack of intention.

Far from pure ––

with calculated aloofness.

How soon it forgets,

though rarely forgives

our shared history.

Priding the consumer's need

in its sustenance and power.

Its fabric no longer delicately woven

from dreams of multicolored shepherds

set free,

seeking to heal.

Now mass produced,

fit to provide

for an economy of its kind.

Forgetting that without you,

I am not.

May wrinkles and stains fall upon it,

graceful reminders of its truth.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-04-19T09:00:38-07:00info:doi/10.1136/medhum-2017-011238hwp:master-id:medhum;medhum-2017-011238Institute of Medical Ethics2017-04-19Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011207v1?rss=1

"The parents of my 28-week preemie twins stopped me in the garage".

He broke the sleepy and blissful silence.

She knew it would be another sad story.

"They pleaded with me to decide which one to let go, for lack of money".

"Mom-and-wife-drowning-at-the-same-time situation?"

"Yep, a close contest".

Yet, this time, the dreadful question was not asked by the jealous wife,

but by a poverty-stricken couple,

who believed that he could save the day, as he had done before.

But they never knew their

helplessness, desperation, trust, artlessness, or whatever,

were drowning another human soul alive.

Bio

Jiena Sun received her PhD in American Contemporary Literature, with a special focus on physician writers, from SUNY-Binghamton in 2012. She is an associate professor in the English Department of Wuhan University, PR China. She has published in Medical Humanities, Interdisciplinary Literary Studies and other Chinese journals. Her dissertation was published in China in 2014. She is currently working on her second book manuscript on contemporary...]]>

2017-04-11T09:00:28-07:00info:doi/10.1136/medhum-2017-011207hwp:master-id:medhum;medhum-2017-011207Institute of Medical Ethics2017-04-11Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2016-011167v1?rss=1
Hearing voices in the absence of another speaker—what psychiatry terms an auditory verbal hallucination—is often associated with a wide range of negative emotions. Mainstream clinical research addressing the emotional dimensions of voice-hearing has tended to treat these as self-evident, undifferentiated and so effectively interchangeable. But what happens when a richer, more nuanced understanding of specific emotions is brought to bear on the analysis of distressing voices? This article draws findings from the ‘What is it like to hear voices’ study conducted as part of the interdisciplinary Hearing the Voice project into conversation with philosopher Dan Zahavi's Self and Other: Exploring Subjectivity, Empathy and Shame to consider how a focus on shame can open up new questions about the experience of hearing voices. A higher-order emotion of social cognition, shame directs our attention to aspects of voice-hearing which are understudied and elusive, particularly as they concern the status of voices as other and the constitution and conceptualisation of the self.]]>2017-04-07T09:00:29-07:00info:doi/10.1136/medhum-2016-011167hwp:master-id:medhum;medhum-2016-011167Institute of Medical Ethics2017-04-07Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011242v1?rss=1
Introduction

Narrative Medicine has emerged as a discipline from within the medical humanities1 and takes inspiration from philosophy, literature, poetry, art and social sciences theories. In particular, it is underpinned by philosophical approaches such as phenomenology, postmodernism and narratology, proposing that clinicians must attend to the lived experience of their patients and apply the science to the person.2 Meanwhile, the link between medicine and literature is evident in the growing volume of texts written about professionals', or lay people's experiences of illness and disease.3–8 In exploring this link further, Charon9 has contributed greatly to consolidate the theory of Narrative Medicine. She defines it as ‘medicine practiced with the narrative competencies to recognise, absorb, interpret and be moved by the stories of illness’.9 She suggests that, in exploring texts and reading...]]>

2017-04-06T09:00:31-07:00info:doi/10.1136/medhum-2017-011242hwp:master-id:medhum;medhum-2017-011242Institute of Medical Ethics2017-04-06Educational case studyhttp://mh.bmj.com/cgi/content/short/medhum-2016-011099v1?rss=1
While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in high-income countries by injecting drug use, and it is the stigmatising association between the two which is deeply problematic for those with HCV. A qualitative study undertaken in 2002 found that disclosure in health settings places those with HCV in positions of pronounced vulnerability. Disclosure is a primal scene, an interface, where the stigma of HCV, replete with connotations of disease and deviance, potentially transforms those affected into shamed subjects. Standard precautions protect health workers and minimise the transmission of contagion, measures which, in theory, also mitigate the requirement of those with BBVs to unnecessarily disclose their blood status. However, questions on pre-employment health checks, concerns that health treatments might adversely affect the liver and an ethical need to pre-emptively inform healthcare professionals undertaking exposure prone procedures are occasions when those with HCV confront the decision to disclose their blood status. This paper employs Goffman's model of actual and virtual social identities, along with Douglas' notion of dirt and pollution, to examine the dilemmas around disclosure those with HCV negotiate within the health setting. Discriminatory responses by healthcare professionals elucidate the stigmatising potential HCV carries. The subsequent reticence by those with HCV to disclose their blood status risks less than optimum healthcare. Recent studies indicate that stigma occurring in health settings remains a perennial concern for those with HCV.]]>2017-03-31T09:00:27-07:00info:doi/10.1136/medhum-2016-011099hwp:master-id:medhum;medhum-2016-011099Institute of Medical Ethics2017-03-31Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011138v1?rss=1
The moment a serious diagnosis is announced creates an important crisis for a patient, as it shifts their sense of self and of their future potential. This essay discusses the creative representation and use of this diagnostic moment in film narratives. Using Still Alice, A Late Quartet, Wit and Cléo from 5 to 7 as examples, we describe how each of these uses the diagnostic moment in relation to narrative construction and characterisation in recognisable ways. We associate the diagnostic moment with certain narrative and visual devices that are frequently implemented in films as means for character development, and for managing the audience's empathy. This is the case whether or not the diagnosis is contested or accepted, and whether the diagnostic moment is the frame for the narrative, or a closing device. By analysing its representation in film, we emphasise the cultural significance of diagnosis as a life-transforming event.]]>2017-03-14T09:00:27-07:00info:doi/10.1136/medhum-2016-011138hwp:master-id:medhum;medhum-2016-011138Institute of Medical Ethics2017-03-14Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2017-011220v1?rss=1

A fullness in the neck,

a slight fluttering of the heart,

a warmness of the skin.

No need for coats or heating.

And then the crescendo of the flutterings,

all goes quiet with the feeling of being

removed and disconnected from the body.

All energy seeped out now.

The pill is swallowed and abstinence follows.

And gradually, the crescendos lessen;

we are now in the second movement of this concerto,

diminuendo or andante perhaps?

Further visits for the jelly but the nemesis remains,

hidden from the waves. Beware the silence now,

as the flutterings may return at any time

with renewed vigour. Be vigilant for vivace

as andante may not last forever.

Will this concerto ever end?

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-03-10T09:00:27-08:00info:doi/10.1136/medhum-2017-011220hwp:master-id:medhum;medhum-2017-011220Institute of Medical Ethics2017-03-10Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011204v1?rss=1

unforgettable but

beyond

recollection

a single sanguine sample

declares its delinquency

dolor rubor

the fulmination inside her head

crimson crawling along her silken web

wracking nerves

a family waits, wonders, and bargains

inside, strangers purport to understand

humans and their humours they hope

anatomy, capricious as it is, will now

permit them entry

anaesthesia standing by, Neith reminds them yet again

a moment astray and the web is unwound

they bate their breaths so that she may breathe

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-03-08T09:00:25-08:00info:doi/10.1136/medhum-2017-011204hwp:master-id:medhum;medhum-2017-011204Institute of Medical Ethics2017-03-08Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011221v1?rss=1
Non-suicidal self-injury (NSSI) represents a critical global health concern. While our understanding of NSSI has evolved dramatically over past two decades,1 the language used to refer to those who self-injure has not. Terms such as self-injurer and self-harmer continue to be used throughout the empirical literature2 and likely in clinical settings. From a humanistic standpoint, these referents may perpetuate unhelpful discourses and exacerbate the stigma that many individuals already experience by labelling and ostensibly equating them with the behaviour enacted. Indeed, guidelines have been offered to improve and offer a more socially judicious nomenclature when referring to those who experience mental health difficulties (eg, avoiding terms such as schizophrenic). However, the use of self-injurer or self-harmer fail cohere with such efforts. Clinically, these terms may be inadequate and impractical in the sense that they seemingly connote similarity across individuals who self-injure by grouping them together. This...]]>2017-03-06T09:00:24-08:00info:doi/10.1136/medhum-2017-011221hwp:master-id:medhum;medhum-2017-011221Institute of Medical Ethics2017-03-06PostScripthttp://mh.bmj.com/cgi/content/short/medhum-2016-011183v1?rss=1

Wandering the hallways of my mind.

I am lost.

Searching,

Familiarity and mystery lie waiting around every corner. But which corner?

Wandering.

Shadows of a face I once knew so well,

Figures shrouded in the mists of time,

Fading beyond the reach of an outstretched arm.

Wandering.

The soft patter of little feet,

The gentle curve of a reluctant smile,

The warm tears of unkind years,

Wandering.

Wandering the hallways of my mind.

Wandering,

Wandering,

Wandering.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-02-23T09:00:32-08:00info:doi/10.1136/medhum-2016-011183hwp:master-id:medhum;medhum-2016-011183Institute of Medical Ethics2017-02-23Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2017-011194v1?rss=1

Who writes the script

and sets in motion the

interdependent dialogue?

It cannot be unwritten

until eyelids close.

Who authors the script?

It cannot be monographic.

The bard's hand should be writing

carefully, coveting

the lines of the patient speaker.

This script is rewritten

every 30 days or more, and

our small cast replays it:

agonist and receptor,

and spectator.

There's no stage, and still I hear

footlit steps—moored depressors—

here and there

a grain of sand

in skittish undertow.

Competing interests

None declared.

Provenance and peer review

Not commissioned; internally peer reviewed.

]]>2017-02-22T09:00:26-08:00info:doi/10.1136/medhum-2017-011194hwp:master-id:medhum;medhum-2017-011194Institute of Medical Ethics2017-02-22Poetry and prosehttp://mh.bmj.com/cgi/content/short/medhum-2016-011133v1?rss=1
The primary claim of this paper is that understanding the stigma so commonly endured by chronic pain sufferers today in the USA and the UK is unlikely without proper appreciation of the history of pain. Ameliorating such stigma is an ethical imperative, and yet most approaches eschew even an attempt to trace connections between historical attitudes, practices and beliefs towards pain and the stigmatisation so many pain sufferers currently endure. The manuscript aims to help fill this gap by framing pain in the modern era in context of two crucial intellectual schemes that waxed in the 19th and 20th centuries: mechanical objectivity and somaticism. The analysis explains these frameworks and applies them to exploration of primary sources connected to contested pain conditions such as railway spine. By properly situating the historical roots of what it means to cite the ‘subjectivity’ of pain as a problem, the modern roots of stigmatising attitudes and practices towards chronic pain sufferers become much clearer. The manuscript concludes by suggesting that interventions expressly intended to target the root causes of such stigma are much more likely to be successful than approaches that proceed in ignorance of the historical forces shaping and driving pain stigma in the present.]]>2017-02-21T23:11:40-08:00info:doi/10.1136/medhum-2016-011133hwp:master-id:medhum;medhum-2016-011133Institute of Medical Ethics2017-02-21Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011135v1?rss=1
Despite a growing prevalence of mental illness diagnoses and treatments, there remains remarkable interpretive diversity regarding the meaning of these diagnoses and their implication for mental healthcare. Humanities scholarship devoted to language, power and ethical cares of the self provides invaluable tools for navigating interpretive diversity in this domain. This scholarship suggests that ethical questions of informed consent regarding mental difference and disability go much deeper than the usual standards. Ethical questions of informed consent go back to the very language choices people use to narrate and navigate the mental difference or disability. Making these ethical choices between different ways of understanding psychic difference is fundamentally about making narrative and lifestyle choices. This article considers these issues in the context of the many interpretations of Vincent van Gogh's life and their ongoing relevance for contemporary approaches to mental difference and disability.]]>2017-02-17T09:00:34-08:00info:doi/10.1136/medhum-2016-011135hwp:master-id:medhum;medhum-2016-011135Institute of Medical Ethics2017-02-17Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011052v1?rss=1
This article analyses the concept of narrative empathy in illness memoirs. These texts negotiate the narrative identity of an autobiographer as he or she recounts the disruptive experience of illness, an experience in which physical and emotional traces dramatically and definitively shape our sense of self. While narrative emotions are certainly deployed in these autobiographies in order to connect with the readers and promote social change, this empathic connection is not so much aimed at arousing compassion but rather more positive emotions on the experience of illness. I will explore the emotional representations of cancer in Arthur Frank's At the Will of the Body (1991) and Kathlyn Conway's Ordinary Life: A Memoir of Illness (1997), focusing on the identity strategies these authors use in order to become affirmative models of disability and illness, showing the damaging effects not of disease or impairment but, rather, of the cultural mythologies that interpret those conditions in reductive or disparaging ways.]]>2017-02-15T09:00:28-08:00info:doi/10.1136/medhum-2016-011052hwp:master-id:medhum;medhum-2016-011052Institute of Medical Ethics2017-02-15Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011065v1?rss=1
Disabled people are said to experience stigma because their embodied presence in the world does not fit with how others interact and use their bodies to be social participants. In response they can turn to medical procedures, such as surgery or physiotherapy, in order to reshape their bodies to more closely approximate norms of social interaction and embodiment. This paper explores how medicine plays a role in attempts to be recognised by others as normal and acceptable by minimising disability. It will do so via a focus on disabled young people, in order to explore how their emerging identities and aspirations for the future influence how they think about their bodies, what normality means and their participation in multiple activities that work on their bodies. The paper draws from an Economic and Social Research Council (ESRC) project that used a range of qualitative research methods with a group of disabled young people. The project explored ways in which participants actively worked on their bodies to be more normal and examined the disciplinary and agency dynamics involved in this work.]]>2017-02-06T09:00:29-08:00info:doi/10.1136/medhum-2016-011065hwp:master-id:medhum;medhum-2016-011065Institute of Medical Ethics2017-02-06Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011057v1?rss=1
This article offers a historical corollary to the examination of shame in medical practice by considering the negotiation of shame in the treatment of a stigmatised disease at a time in which surgeons themselves occupied a highly ambivalent social position. It will focus on case studies provided by Daniel Turner (1667–1741), prominent surgeon and later member of the College of Physicians, in his textbooks De Morbis Cutaneis. A Treatise of Diseases Incident to the Skin (1714) and Syphilis. A Practical Dissertation on the Venereal Disease (1717). Turner demonstrates an awareness of the precarious position of both the surgeon and the syphilitic, and devotes significant portions of his text to advising the trainee surgeon on how to manage patients' reticence over disclosure of symptoms, expectations for cure and impudence towards medical authority. In turn, the trainee must manage his own reputation as a moral and medical authority who can treat all distempers, yet without condoning or facilitating the shameful behaviours associated with a sexual disease. Furthermore, shaming plays a key role in enabling Turner to fashion an ideal patient whose successful cure will both respond to and build the surgeon's medical authority and that of the medical field in general.]]>2017-01-17T09:00:29-08:00info:doi/10.1136/medhum-2016-011057hwp:master-id:medhum;medhum-2016-011057Institute of Medical Ethics2017-01-17Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011079v1?rss=1
Recently, the involvement of various authors coming from the social sciences and the arts has reinforced the humanistic component of bioethics. Their contributions vary from very theoretical perspectives to rather practical ones. In this paper, Martha Nussbaum's books, The Fragility of Goodness (1986), Love's Knowledge (1990), Cultivating Humanity (1997) and Creating Capabilities (2011) are analysed from the vantage point of narrative bioethics. It is argued that Nussbaum's notions of ‘Narrative’, ‘Imagination’ and ‘Cultivation’ open up the possibility of developing an action-oriented form of narrative bioethics, that is, a bioethics committed to social action and justice.]]>2017-01-13T09:00:47-08:00info:doi/10.1136/medhum-2016-011079hwp:master-id:medhum;medhum-2016-011079Institute of Medical Ethics2017-01-13Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011113v1?rss=1
Isabelle Dinoire, the world's first face transplant recipient has died, 11 years after the procedure that brought her unwanted fame and media attention. While medical debates centre mainly on ethical and medical concerns like immunosuppressant use, the psychological hazards of face transplants are still being overlooked. Using medical and media reports and examining the gendering of clinical and patient narratives, this article argues we need to look again at face transplants and their motivation for individuals as well as society.]]>2016-12-09T09:00:48-08:00info:doi/10.1136/medhum-2016-011113hwp:master-id:medhum;medhum-2016-011113Institute of Medical Ethics2016-12-09Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011047v1?rss=1
The case for psychosocial interventions in relation to chronic pain, one of the most common health issues in contemporary healthcare, is well-established as a means of managing the emotional and psychological difficulties experienced by sufferers. Using mixed methods, this study compared a standard therapy for chronic pain, cognitive behavioural therapy (CBT), with a specific literature-based intervention, shared reading (SR) developed by national charity, The Reader. A 5-week CBT group and a 22-week SR group for patients with chronic pain ran in parallel, with CBT group members joining the SR group after the completion of CBT. In addition to self-report measures of positive and negative affect before and after each experience of the intervention, the 10 participants kept twice-daily (12-hourly) pain and emotion diaries. Qualitative data were gathered via literary-linguistic analysis of audio/video-recordings and transcriptions of the CBT and SR sessions and video-assisted individual qualitative interviews with participants. Qualitative evidence indicates SR's potential as an alternative or long-term follow-up or adjunct to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by patients with chronic pain. In addition, quantitative analysis, albeit of limited pilot data, indicated possible improvements in mood/pain for up to 2 days following SR. Both findings lay the basis for future research involving a larger sample size.]]>2016-12-09T09:00:48-08:00info:doi/10.1136/medhum-2016-011047hwp:master-id:medhum;medhum-2016-011047Institute of Medical Ethics2016-12-09Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-011023v1?rss=1
Previous influenza pandemics are usually invoked in pandemic preparedness planning without a thorough analysis of the events surrounding them, what has been called the ‘configuration’ of epidemics. Historic pandemics are instead used to contrast them to the novelty of the coming imagined plague or as fear of a ghost-like repetition of the past. This view of pandemics is guided by a biomedical framework that is ahistorical and reductionist. The meaning of ‘pandemic’ influenza is in fact highly ambiguous in its partitioning of pandemic and seasonal influenza. The past 200 years of influenza epidemics in Sweden are examined with a special focus on key social structures—households, schools, transportations and the military. These are shown to have influenced the progression of influenza pandemics. Prevailing beliefs around influenza pandemics have also profoundly influenced intervention strategies. Measuring long-term trends in pandemic severity is problematic because pandemics are non-linear events where the conditions surrounding them constantly change. However, in a linearised view, the Spanish flu can be seen to represent a historical turning point and the H1N1 2009 pandemic not as an outlier, but following a 100-year trend of decreasing severity. Integrating seasonal and pandemic influenza, and adopting an ecosocial stance can deepen our understanding and bring the ghost-like pandemic past to life.]]>2016-11-08T09:00:30-08:00info:doi/10.1136/medhum-2016-011023hwp:master-id:medhum;medhum-2016-011023Institute of Medical Ethics2016-11-08Original articlehttp://mh.bmj.com/cgi/content/short/medhum-2016-010874v1?rss=1
The sudden death of Pablo Picasso's closest friend Carlos Casagemas in 1901 came as a great shock to the young Picasso. From a young age, Picasso had ruminated on life and death; however, this was his first experience of bereavement. Following the death of Casagemas, Picasso's paintings can be seen as a diary of his grieving process and clearly illustrate the five stages of the grieving process as outlined by Kubler-Ross in ‘On Death and Dying’ (1969).]]>2016-06-10T09:00:37-07:00info:doi/10.1136/medhum-2016-010874hwp:master-id:medhum;medhum-2016-010874Institute of Medical Ethics2016-06-10Original article